An Examination of the Association of Distress Intolerance and Emotion Regulation with Avoidance

McHugh, R. Kathryn; Reynolds, Elizabeth K.; Leyro, Teresa M.; Otto, Michael W.

doi:10.1007/s10608-012-9463-6

Cited by 99Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPersonality Disorders and PsychopathologyChild and Adolescent Psychosocial and Emotional Development

An Examination of the Association of Distress Intolerance and Emotion Regulation with Avoidance

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McHugh, R. Kathryn, Reynolds, Elizabeth K., Leyro, Teresa M., Otto, Michael W.·2013·Cognitive Therapy and Research

DOI 10.1007/s10608-012-9463-6PMC PMC7410348

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Abstract

Distress intolerance is an important motivator of maladaptive avoidance-based coping strategies. The selection of such avoidance behaviors is also influenced by one's access to alternative emotion regulatory strategies. However, little research has examined the relative contributions of these vulnerability factors to avoidance. This study examined whether distress intolerance and access to emotion regulation strategies were uniquely (additively or interactively) associated with self-reported avoidance. Two samples-an unselected sample (n = 300) and a clinical sample (n = 100)-comprised of patients seeking treatment for unipolar mood and/or anxiety disorders were administered measures of distress intolerance, emotion regulation, and avoidance. Results of linear regression analyses indicated that distress intolerance and access to emotion regulation strategies were uniquely and additively associated with avoidance. Implications for the prevention and treatment of psychological disorders are discussed.

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In non-autistic samples, lower distress tolerance and emotion regulation abilities both contribute to greater avoidance-based coping.
“For example, lower DT and ER abilities both contribute to greater avoidance-based coping (McHugh et al., 2013).”
From The relationship between distress tolerance and behavioral activation on anxiety and depression symptomatology in autistic youth: Leveraging self and caregiver perspectives (2024) · cites this paper as McHugh et al., 2013
Because distress tolerance is a transdiagnostic mechanism, transdiagnostic interventions can be expected to increase levels of distress tolerance.
“Since distress tolerance is a transdiagnostic mechanism (e.g., [20]), transdiagnostic interventions can be expected to increase levels of distress tolerance.”
From The Factorial Structure, Psychometric Properties and Sensitivity to Change of the Distress Tolerance Scale for Children with Emotional Disorders. (2024) · cites this paper as [20]

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Gratz, K. L., & Roemer, L. (2004) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/b:joba.0000007455.08539.94 · Cited by 8,942 · see citing works
Measuring experiential avoidance: A preliminary test of a working model
Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., et al. (2004) · The Psychological Record · doi:10.1007/bf03395492 · Cited by 2,140 · see citing works
Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder
Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K., & Lindenboim, N. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.7.757 · Cited by 2,025 · see citing works
The Distress Tolerance Scale: Development and Validation of a Self-Report Measure
Simons, J. S., & Gaher, R. M. (2005) · Motivation and Emotion · doi:10.1007/s11031-005-7955-3 · Cited by 1,730 · see citing works
Distress tolerance and psychopathological symptoms and disorders: A review of the empirical literature among adults.
Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010) · Psychological Bulletin · doi:10.1037/a0019712 · Cited by 868 · see citing works
Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder
Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.05.017 · Cited by 426 · see citing works
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“…with behavioral and electrophysiological response to emotional stimuli (Cochrane et al. 2007) and has been associated with a range of negative outcomes, such as greater reactivity to fear exposure (Feldner et al. 2003) and depressive and anxiety symptoms related to health (Andrew and Dulin 2007).”
Background
Emotion Dysregulation and Negative Affect
Bradley, B., DeFife, J. A., Guarnaccia, C., Phifer, J. E., Fani, N., Ressler, K. J., & Westen, D. (2011) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.10m06409blu · Cited by 306 · see citing works
The Frustration Discomfort Scale: development and psychometric properties
Harrington, N. (2005) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.465 · Cited by 248 · see citing works
Initial RCT of a distress tolerance treatment for individuals with substance use disorders
Bornovalova, M. A., Gratz, K. L., Daughters, S. B., Hunt, E. D., & Lejuez, C. W. (2012) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2011.09.012 · Cited by 210 · see citing works
Mechanism of Change in Cognitive-Behavioral Treatment of Panic Disorder: Evidence for the Fear of Fear Mediational Hypothesis.
Smits, J. A. J., Powers, M. B., Cho, Y., & Telch, M. J. (2004) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.72.4.646 · Cited by 203 · see citing works
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Background
An evaluation of the relation between distress tolerance and posttraumatic stress within a trauma-exposed sample
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Leyro, T. M., Bernstein, A., Vujanovic, A. A., McLeish, A. C., & Zvolensky, M. J. (2011) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-010-9197-2 · Cited by 130 · see citing works
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“The AAQ has demonstrated adequate retest and internal consistency reliability in large clinical and non-clinical samples (Hayes et al. 2004) and decreases in AAQ scores are associated with treatment response (Hayes et al. 2010).”
Background
Domain-general and domain-specific strategies for the assessment of distress intolerance.
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MacPherson, L., Reynolds, E. K., Daughters, S. B., Wang, F. M., Cassidy, J. A., Mayes, L. C., & Lejuez, C. W. (2010) · Prevention Science · doi:10.1007/s11121-010-0172-7 · Cited by 81 · see citing works
The relationship between self-reported health and mental health problems among older adults in New Zealand: experiential avoidance as a moderator
Andrew, D. H., & Dulin, P. L. (2007) · Aging & Mental Health · doi:10.1080/13607860601086587 · Cited by 79 · see citing works
Posttraumatic Stress and Alcohol Use Motives
Vujanovic, A. A., Marshall‐Berenz, E. C., & Zvolensky, M. J. (2011) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.25.2.130 · Cited by 58 · see citing works
Experiential avoidance and aversive visual images: Response delays and event-related potentials on a simple matching task
Cochrane, A., Barnes‐Holmes, D., Barnes‐Holmes, Y., Stewart, I., & Luciano, C. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.05.010 · Cited by 29 · see citing works
The role of mindful attention in regard to the relation between negative affect reduction outcome expectancies and emotional vulnerability among adult cigarette smokers
Gonzalez, A., Vujanovic, A. A., Johnson, K. A., Leyro, T. M., & Zvolensky, M. J. (2009) · Cognitive Therapy and Research · doi:10.1007/s10608-009-9246-x · Cited by 20 · see citing works

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Preece, D. A., Becerra, R., Robinson, K., & Gross, J. J. (2020) · Journal of Personality Assessment · doi:10.1080/00223891.2018.1564319 · Cited by 237 · see citing works
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Improvement in Distress Tolerance as a Mechanism of Symptom Reduction During Intensive Exposure and Response Prevention–Based Treatment for OCD
Godfrey, D. A., Heinrich, A., McIngvale, E., Sy, J. T., Wheaton, M. G., & Björgvinsson, Þ. (2024) · Behavior Therapy · doi:10.1016/j.beth.2023.12.006 · Cited by 7 · see citing works
Differences in Distress Intolerance Among Daily and Intermittent Smokers.
Veilleux, J., & Skinner, K. D. (2019) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntz237 · Cited by 8 · see citing works
Regret for Complaint Withholding
Liu, E., & Roloff, M. E. (2015) · Communication Quarterly · doi:10.1080/01463373.2015.1103280 · Cited by 7 · see citing works
Advances in Theoretical, Developmental, and Cross-Cultural Perspectives of Psychopathology
Coulacoglou, C., & Saklofske, D. H. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-802219-1.00011-0 · Cited by 7 · see citing works
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Keller, A. E., Langer, D. A., Pincus, D. B., Elkins, R. M., Kerns, C. E., & Comer, J. S. (2018) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-018-9711-5 · Cited by 7 · see citing works
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Kremyar, A. J., & Lee, T. T. C. (2021) · Assessment · doi:10.1177/10731911211001948 · Cited by 7 · see citing works
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Shaw, J. L., & Kelly, A. C. (2024) · Mindfulness · doi:10.1007/s12671-024-02312-x · Cited by 5 · see citing works
Postpartum experiences among individuals with suspected and confirmed prenatal generalized anxiety disorder during the COVID-19 pandemic: Implications for help-seeking
Koire, A. M., Feldman, N., Erdei, C., Mittal, L. P., & Liu, C. H. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115169 · Cited by 6 · see citing works
The relationship between perceived stress and bedtime procrastination among Chinese college students: a moderated mediation model
He, Q., Wu, H., Meng, X.-L., & Li, C.-L. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1547389 · Cited by 5 · see citing works
Fight or Flight? Curvilinear Relations between Previous Cyberbullying Victimization Experiences and Continuous Use of Social Media: Social Media Rumination and Distress as Chain Mediators
Gu, C., Liu, S., & Chen, S. (2022) · Behavioral Sciences · doi:10.3390/bs12110421 · Cited by 5 · see citing works
The Construct Validity of Distress Intolerance: Is it Distinct from Demoralization and Negative Emotionality?
Kremyar, A. J., Tarescavage, A. M., & Ben‐Porath, Y. S. (2019) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-019-09764-9 · Cited by 5 · see citing works
Influence of Sensation Seeking and Life Satisfaction Expectancy on Stock Addiction Tendency: Moderating Effect of Distress Tolerance
Son, M., & Jeong, G.-C. (2023) · Behavioral Sciences · doi:10.3390/bs13050378 · Cited by 5 · see citing works
Parent Distress Intolerance, Repetitive Negative Thinking, and Mental Health Service Use
Patel, Z. S., Casline, E. P., Jensen‐Doss, A., & Timpano, K. R. (2020) · Child Psychiatry & Human Development · doi:10.1007/s10578-020-01017-1 · Cited by 5 · see citing works
A Model Of Distress Tolerance In Self-Damaging Behaviors: Examining The Role Of Emotional Reactivity And Learned Helplessness
Sommers, B. (2017) · doi:10.32597/dissertations/1633 · Cited by 5 · see citing works
The Structural Relationships among Optimism, Distress Tolerance, Grief Avoidance, Intrusive Rumination, Deliberate Rumination, and Psychological Well-Being on Undergraduates Exposed to Loss
Kim, L. Y., & Jang, J. Y. (2020) · Korean Journal of Stress Research · doi:10.17547/kjsr.2020.28.3.107 · Cited by 5 · see citing works
Moderating Effect of Distress Tolerance on the Relationship Between Negative Affect Intensity and Adaptive and Maladaptive Emotion Regulation Strategies
이지영, & 정지현 (2016) · Korean Journal of Health Psychology · doi:10.17315/kjhp.2016.21.4.003 · Cited by 5 · see citing works
The Role of Mass Media in Influencing the Lifestyle of the Elderly during the COVID-19 Pandemic
Șargu, L., Andrioni, F., Popp, L. E., Netedu, A., Bularca, M. C., Otovescu, A., Motoi, G., Negrilă, I., Goian, C., Coman, C., et al. (2023) · Healthcare · doi:10.3390/healthcare11131816 · Cited by 4 · see citing works
Unsupportive romantic partner behaviors increase neural reactivity to mistakes
Palmwood, E. N., & Simons, R. F. (2021) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2021.09.008 · Cited by 3 · see citing works
The Mediating Roles of Affect Lability and Experiential Avoidance Between Distress Tolerance and Suicidal Ideation Among College Students
Baker, S. N., Burr, E. K., Leon, A. N. D., Leary, A. V., Rozek, D. C., & Dvorak, R. D. (2023) · Psychological Reports · doi:10.1177/00332941231216671 · Cited by 3 · see citing works
Distress Intolerance Is Associated With Emotion Regulation Effort and Difficulty, But Not Success in Daily Life
Gross, A. M., Eckland, N. S., & Thompson, R. J. (2025) · Behavior Therapy · doi:10.1016/j.beth.2025.11.005 · Cited by 2 · see citing works
Development and preliminary validation of a scale to assess physicians’ emotional distress intolerance in end-of-life care communication
Brondolo, E. N., Keating, L., Crete, A., Kaur, A., Randrianarivony, R., Statman, D., Schwartz, J. E., Basello, G., & Roth, A. R. (2022) · Palliative & Supportive Care · doi:10.1017/s1478951522000219 · Cited by 2 · see citing works
Experienced Versus Perpetrated Intimate Partner Violence and Psychological Maladjustment: The Role of Adaptive and Avoidant Coping
Nagoshi, J. L., Nagoshi, C. T., Akter, F., & Pillai, V. K. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22010036 · Cited by 2 · see citing works
A Psychometric Investigation of the Distress Tolerance Scale Short Form (DTS-SF): Reliability, Validity, and Factor Structure in a Trauma-Exposed Sample
Byllesby, B. M., Charak, R., Cano-González, I., & Christ, N. M. (2025) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-025-10226-8 · Cited by 2 · see citing works
Distress tolerance among emergency department patients in acute pain: Associations with substance use treatment
Pacella‐LaBarbara, M. L., Maltese, C., McConaghy, M., Porter, J., Young, M. L., & Suffoletto, B. P. (2020) · Stress and Health · doi:10.1002/smi.3020 · Cited by 2 · see citing works
Maternal alcohol dependence symptoms, maternal insensitivity to children’s distress, and young children’s blunted emotional reactivity
Jacques, D. T., Sturge‐Apple, M. L., Davies, P. T., & Cicchetti, D. (2024) · Development and Psychopathology · doi:10.1017/s0954579424000324 · Cited by 2 · see citing works
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Schwartzman, J. M., Antezana, L., & Conner, C. M. (2024) · Autism Research · doi:10.1002/aur.3208 · Cited by 1 · see citing works
“For example, lower DT and ER abilities both contribute to greater avoidance-based coping (McHugh et al., 2013).”
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Cole, J., & Logan, T. (2024) · Journal of Drug Issues · doi:10.1177/00220426241252336 · Cited by 1 · see citing works
Longitudinal associations of physical and emotional distress tolerance with pain intensity and pain-related disability in United States combat veterans
Wild, M. G., Mendoza, C., Herbert, M. S., & Creech, S. K. (2026) · Journal of Behavioral Medicine · doi:10.1007/s10865-026-00684-0 · Cited by 1 · see citing works
Examining the Relation Between Physiological and Psychological Components of Stress Reactivity and Recovery in Cigarette Smokers
Borges, A. M., Selby, E. A., Bates, M. E., Zvolensky, M. J., & Leyro, T. M. (2019) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-019-09429-z · Cited by 1 · see citing works
Work hope and the socioemotional functioning of offenders
Guion, D. B. (2013) · VCU Scholars Compass (Virginia Commonwealth University) · doi:10.25772/6r15-df78 · Cited by 1 · see citing works
The Relationship between Distress Tolerance, Parenting, and Substance Use Among Adolescent Mothers
Im, J. (2021) · doi:10.7916/d8-4haz-vk57 · Cited by 1 · see citing works
Can distress tolerance predict chronic worry? Investigating the relationships among worry, distress tolerance, cognitive avoidance, psychological flexibility, difficulties in emotion regulation, and anxiety sensitivity
Sabourin, B. A. (2013) · Cited by 1 · see citing works
Covert Narcissism and Negative Emotions of Female High School Students: the Mediating Effects of Emotional Distress Tolerance and Self-report of Soothing Receptivity
김혜원, & Lee, J. (2016) · The Korea Journal of Youth Counseling · doi:10.35151/kyci.2016.24.1.009 · Cited by 1 · see citing works
Re-examination of the Latent Structure of the Distress Intolerance Index
Klein, K. P., Bartholomay, E. M., Stevens, K. T., Harris, E. K., Björgvinsson, Þ., & Kertz, S. J. (2021) · International Journal of Cognitive Therapy · doi:10.1007/s41811-021-00103-z · Cited by 1 · see citing works
Using Bayesian Variable Selection to Identify Predictors of Psychological Functioning Post Hurricane IrmaPreprint
Bainter, S. A., Goodman, Z., Stamatis, C. A., Broos, H. C., Llabre, M. M., Zvolensky, M. J., & Timpano, K. R. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4100137 · Cited by 1 · see citing works
Why Do Adolescents Use Maladaptive Emotion Regulation Strategies? The Role of Perceived Effectiveness, Distress Tolerance, and Impulsivity
Moran, K. M. (2016) · doi:10.33915/etd.6256
Behavioral Inhibition and Avoidance: Identifying Vulnerabilities to Avoidant Behavior
Pineau, D. (2019)
Multidimensional factors associated with perceived risk of HIV among sexually experienced individuals in Portugal
Martins, A., Canavarro, M. C., & Pereira, M. (2021) · Psychology and Sexuality · doi:10.1080/19419899.2021.1933146
Investigation of the Relative Contributions of Distress Tolerance, Anxiety Sensitivity, and Experiential Avoidance to Predisposing of Disordered EatingPreprint
Mayeli, P., Yousefi, S., & Ashouri, A. (2023) · Research Square · doi:10.21203/rs.3.rs-3298893/v1 · Cited by 2 · see citing works
Preliminary evidence for the utility of a videogame as a behavioral measure of distress intolerance
Vargo, L. A., Buckner, J. D., & Graham, R. (2024) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2024.43.6.519
Understanding Frustration Intolerance: Validation and Analysis of the Spanish Frustration Discomfort Scale
Suso‐Ribera, C. (2026) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-026-00638-0
To Regulate or Not to Regulate? Situational and Individual Differences in Emotion Regulation Initiation in Daily Life
Springstein, T., Bankston, A., & English, T. (2026) · Personality and Social Psychology Bulletin · doi:10.1177/01461672261461318
Understanding the Role of Distress Intolerance in a Digital Safety Behavior Intervention for Appearance Concerns
Patel, T. A., & Cougle, J. R. (2026) · Behavior Therapy · doi:10.1016/j.beth.2026.09.004
Mindfulness as a mediator between distress intolerance and mental health: a prospective two-wave study
Belen, H., & Öztürk, F. (2026) · Current Psychology · doi:10.1007/s12144-026-09953-2
An Examination of the Moderators to the Effect of a Brief Mindfulness Intervention for Acute Pain
Pineau, D. (2015) · OpenSIUC (Southern Illinois University Carbondale)

Distress Tolerance Predicts Day-To-Day Emotion Regulation Behaviors
Carrillo, L. (2019) · W&M Publish (College of William & Mary) · doi:10.21220/s2-b6pm-zy79 · Cited by 2 · see citing works
Investigating How Intolerance of Uncertainty and Emotion Regulation Predict Experiential Avoidance in Non-Clinical Participants
Giuseppe, K. D., & Taylor, A. (2021) · Psychological Studies · doi:10.1007/s12646-021-00602-1 · Cited by 10 · see citing works
The Role of Distress Tolerance in the Use of Specific Emotion Regulation Strategies
Jeffries, E. R., McLeish, A. C., Kraemer, K. M., Avallone, K. M., & Fleming, J. B. (2016) · Behavior Modification · doi:10.1177/0145445515619596 · Cited by 105 · see citing works
Intolerance of uncertainty and emotion regulation: A meta-analytic and systematic review
Sahib, A., Chen, J., Cárdenas, D., & Calear, A. L. (2023) · Clinical Psychology Review · doi:10.1016/j.cpr.2023.102270 · Cited by 124 · see citing works
The structure of common emotion regulation strategies: A meta-analytic examination
Naragon-Gainey, K., McMahon, T. P., & Chacko, T. P. (2017) · Psychological Bulletin · doi:10.1037/bul0000093 · Cited by 588 · see citing works

Authors: McHugh, R. K., Reynolds, E. K., Leyro, T. M., & Otto, M. W.
Affiliations: Harvard University (US)
Johns Hopkins University (US)
University of California, San Francisco (US)
Boston University (US)
Corresponding author: McHugh, R. Kathryn
ORCID: McHugh, R. Kathryn
Reynolds, Elizabeth K.
Leyro, Teresa M.
Otto, Michael W.
Venue: Cognitive Therapy and Research
Publisher: Springer Science and Business Media LLC
Published: 2012-05-05
Volume: 37
Issue: 2
Pages: 363-367
ISSN: 0147-5916 (ISSN-L)
1573-2819
DOI: 10.1007/s10608-012-9463-6
PMC: PMC7410348
OpenAlex: W1983987630
Cited by: 99
References: 24
Citations by year: 2026: 5 · 2025: 3 · 2024: 12 · 2023: 9 · 2022: 7 · 2021: 11 · 2020: 8 · 2019: 14 · 2018: 5 · 2017: 6 · 2016: 6 · 2015: 5 · 2014: 4 · 2013: 3 · 2012: 1
FWCI: 5.58
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.springer.com/tdm (tdm)
Locations: Cognitive Therapy and Research (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Drug Abuse (T32DA007250)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords: distress intolerance, emotion regulation, avoidance, unipolar mood disorders, anxiety disorders, vulnerability factors, clinical samples, prevention of psychological disorders

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An Examination of the Association of Distress Intolerance and Emotion Regulation with Avoidance

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